It’s important to look at what they define as their primary outcome.
Aspirin was non-inferior to LMWH when it came to death from any cause. However, the rates of venous thrombosis (which is what ASA and LMWH are trying to prevent) was higher in the aspirin group. It was only 0.8% higher, though in a study of over 12 000 patients that equates to an extra 1000 people getting a blood clot and this was statistically significant.
While these blood clots may not have increased mortality, that doesn’t mean they have no morbidity. Patients can get chronic symptoms of swelling and pain after a DVT (called post thrombotic syndrome). This is reported in around 20-50% of patients with DVT, so conservitavely 200 people on the study are likely to have long term symptoms (often lifelong) as a result of being randomized to aspirin. While more rare, there is also risk of cardiac and lung complications after a pulmonary embolism (such as pulmonary hypertension) which can be quite severe.
At my hospital, nearly all patients are on LMWH for VTE prevention and complications from this are exceedingly rare. If it were me in hospital with a fracture, I’d take LMWH over ASA any day.
Source: Hematologist who sees people on blood thinners every working day.
YepYep123 t1_j7yfg7i wrote
Reply to According to a study on 12,211 patients, aspirin is just as effective at preventing blood clots as low molecular weight heparin, but it costs less and is easier to administer by giuliomagnifico
It’s important to look at what they define as their primary outcome.
Aspirin was non-inferior to LMWH when it came to death from any cause. However, the rates of venous thrombosis (which is what ASA and LMWH are trying to prevent) was higher in the aspirin group. It was only 0.8% higher, though in a study of over 12 000 patients that equates to an extra 1000 people getting a blood clot and this was statistically significant.
While these blood clots may not have increased mortality, that doesn’t mean they have no morbidity. Patients can get chronic symptoms of swelling and pain after a DVT (called post thrombotic syndrome). This is reported in around 20-50% of patients with DVT, so conservitavely 200 people on the study are likely to have long term symptoms (often lifelong) as a result of being randomized to aspirin. While more rare, there is also risk of cardiac and lung complications after a pulmonary embolism (such as pulmonary hypertension) which can be quite severe.
At my hospital, nearly all patients are on LMWH for VTE prevention and complications from this are exceedingly rare. If it were me in hospital with a fracture, I’d take LMWH over ASA any day.
Source: Hematologist who sees people on blood thinners every working day.